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    GATT novel 360? ab interno glaucoma procedure

    Findings show dramatic lowering of IOP accompanied by reduced need for medicine

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    Gonioscopy-assisted transluminal trabeculotomy (GATT) is a novel, minimally invasive, ab interno glaucoma surgery that has demonstrated good safety and success in eyes representing a variety of types of open-angle glaucoma, according to Dr Davinder S. Grover, MPH.

    "Suture trabeculotomy has become the gold standard for glaucoma surgery in children, and there is good evidence supporting its effectiveness in adults with primary open-angle and secondary glaucomas," said Dr Grover, attending surgeon and clinician, Glaucoma Associates of Texas, Dallas, Texas, USA.

    "However, ab externo trabeculotomy is a time-consuming, relatively invasive operation that requires numerous conjunctival and scleral sutures and violates the conjunctiva so that it may preclude or diminish the success of subsequent trabeculectomy," he added.

    GATT is a 360 ab interno procedure that is sutureless, spares the conjunctiva, and is relatively safe, according to Dr Grover.

    "Our preliminary experience demonstrates that it lowers IOP and reduces medication burden equally to, if not better, than ab externo circumferential trabeculotomy, and now we look forward to analysing our results from longer follow-up," he said.


    Figure 1: A. Initially a goniotomy is created with a microvitreoretinal blade. B. Schlemm’s canal is then cannulated with a microcatheter, using microsurgical forceps. C. One can appreciate that the catheter has already been passed 2 to 3 clock hours around Schlemm’s canal. D. Given the blinking red light on the distal end of the tip, one can follow the path of the catheter as it travels circumferentially around the canal. The catheter has passed 180 around the canal. E. One can now appreciate that the microcatheter has come full circle around the canal. F. The distal tip of the catheter is retrieved within the anterior chamber using microsurgical forceps. Blood reflux from Schlemm’s canal is normal and usually a prognostic indicator of a successful outcome as well as an intact distal collector system. (Images and video courtesy of Dr Davinder S. Grover, MPH.)
    Dr Grover credited Dr Ronald Fellman, Glaucoma Associates of Texas, with being the 'mastermind' behind GATT, but also acknowledged the role that his colleagues, Dr David Godfrey and Dr Tosin Smith played in the development of this technique.

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    Dr Davinder S. Grover, MPH
    Dr Davinder S. Grover, MPH, is attending surgeon and clinician, Glaucoma Associates of Texas, Dallas, Texas, USA. He may be reached by ...

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